EURORAD ESR

Case 14622

Pyogenic liver abscess: value of MRI including diffusion-weighted imaging for diagnosis and follow-up

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
male, 39 year(s)
 
 
  • Figure 1
    Initial multiphase contrast-enhanced CT
     

    Arterial-phase images (a, b) showed an ill-defined hypoattenuating lesion (arrowheads) in the 8th liver segment, measuring approximately 2 cm in size.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Arterial-phase images (a, b) showed an ill-defined hypoattenuating lesion (arrowheads) in the 8th liver segment, measuring approximately 2 cm in size.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    On portal (c, d) and equilibrium (e) phase images the solitary 2-cm lesion (arrowheads) in the 8th liver segment showed faint, progressive contrast enhancement.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    On portal (c, d) and equilibrium (e) phase images the solitary 2-cm lesion (arrowheads) in the 8th liver segment showed faint, progressive contrast enhancement.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;

    On portal (c, d) and equilibrium (e) phase images the solitary 2-cm lesion (arrowheads) in the 8th liver segment showed faint, progressive contrast enhancement.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 2
    Initial unenhanced and contrast-enhanced liver MRI
     

    T2-weighted images (a,b) showed a 2-cm markedly hyperintense fluid-like lesion (arrowheads) in the 8th liver segment, surrounded by faint oedematous hypersignal (*).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T2-weighted images (a, b) showed a 2-cm markedly hyperintense fluid-like lesion (arrowheads) in the 8th liver segment, surrounded by faint oedematous hypersignal (*).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    High b-value (800) diffusion-weighted imaging (DWI) showed a visually hyperintense region (arrowheads) in the 8th liver segment, measuring approximately 4x3 cm in size.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Corresponding apparent diffusion coefficient (ADC) map image showed a hypointense area of restricted diffusion (arrowhead), moderately smaller than the visually DW-hyperintense area in c and corresponding to its...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Precontrast T1-weighted image confirmed a 4x3 cm ovoid hypointense lesion (arrowheads) in the 8th liver segment.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Dynamic contrast-enhanced study including arterial-dominant (f) acquisition showed internally nonenhancing lesion with thin, regular peripheral and septal enhancement (thin arrows), which persisted over the portal...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Dynamic contrast-enhanced study including arterial-dominant (f) acquisition showed internally nonenhancing lesion with thin, regular peripheral and septal enhancement (thin arrows), which persisted over the portal...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Dynamic contrast-enhanced study including arterial-dominant (f) acquisition showed internally nonenhancing lesion with thin, regular peripheral and septal enhancement (thin arrows), which persisted over the portal...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 3
    Follow-up liver MRI after antibiotic therapy, 6 weeks after Fig.2
     

    Follow-up showed near-complete regression of the liver abscess, with residual subtle T2-weighted hyperintensity (arrowhead in a), normalisation of high b-value DWI signal (b), homogeneous parenchymal enhancemente in...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Follow-up showed near-complete regression of the liver abscess, with residual subtle T2-weighted hyperintensity (arrowhead in a), normalisation of high b-value DWI signal (b), homogeneous parenchymal enhancemente in...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Follow-up showed near-complete regression of the liver abscess, with residual subtle T2-weighted hyperintensity (arrowhead in a), normalisation of high b-value DWI signal (b), homogeneous parenchymal enhancemente in...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
Arterial-phase images (a, b) showed an ill-defined hypoattenuating lesion (arrowheads) in the 8th liver segment, measuring approximately 2 cm in size.
 
Arterial-phase images (a, b) showed an ill-defined hypoattenuating lesion (arrowheads) in the 8th liver segment, measuring approximately 2 cm in size.
 
On portal (c, d) and equilibrium (e) phase images the solitary 2-cm lesion (arrowheads) in the 8th liver segment showed faint, progressive contrast enhancement.
 
On portal (c, d) and equilibrium (e) phase images the solitary 2-cm lesion (arrowheads) in the 8th liver segment showed faint, progressive contrast enhancement.
 
On portal (c, d) and equilibrium (e) phase images the solitary 2-cm lesion (arrowheads) in the 8th liver segment showed faint, progressive contrast enhancement.
 
T2-weighted images (a,b) showed a 2-cm markedly hyperintense fluid-like lesion (arrowheads) in the 8th liver segment, surrounded by faint oedematous hypersignal (*).
 
T2-weighted images (a, b) showed a 2-cm markedly hyperintense fluid-like lesion (arrowheads) in the 8th liver segment, surrounded by faint oedematous hypersignal (*).
 
High b-value (800) diffusion-weighted imaging (DWI) showed a visually hyperintense region (arrowheads) in the 8th liver segment, measuring approximately 4x3 cm in size.
 
Corresponding apparent diffusion coefficient (ADC) map image showed a hypointense area of restricted diffusion (arrowhead), moderately smaller than the visually DW-hyperintense area in c and corresponding to its central portion.
 
Precontrast T1-weighted image confirmed a 4x3 cm ovoid hypointense lesion (arrowheads) in the 8th liver segment.
 
Dynamic contrast-enhanced study including arterial-dominant (f) acquisition showed internally nonenhancing lesion with thin, regular peripheral and septal enhancement (thin arrows), which persisted over the portal venous (g) and equilibrium (h) phases.
 
Dynamic contrast-enhanced study including arterial-dominant (f) acquisition showed internally nonenhancing lesion with thin, regular peripheral and septal enhancement (thin arrows), which persisted over the portal venous (g) and equilibrium (h) phases.
 
Dynamic contrast-enhanced study including arterial-dominant (f) acquisition showed internally nonenhancing lesion with thin, regular peripheral and septal enhancement (thin arrows), which persisted over the portal venous (g) and equilibrium (h) phases.
 
Follow-up showed near-complete regression of the liver abscess, with residual subtle T2-weighted hyperintensity (arrowhead in a), normalisation of high b-value DWI signal (b), homogeneous parenchymal enhancemente in post-contrast T1-weighted acquisition (c).
 
Follow-up showed near-complete regression of the liver abscess, with residual subtle T2-weighted hyperintensity (arrowhead in a), normalisation of high b-value DWI signal (b), homogeneous parenchymal enhancemente in post-contrast T1-weighted acquisition (c).
 
Follow-up showed near-complete regression of the liver abscess, with residual subtle T2-weighted hyperintensity (arrowhead in a), normalisation of high b-value DWI signal (b), homogeneous parenchymal enhancemente in post-contrast T1-weighted acquisition (c).
 
 
 
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